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Child Abuse and Maltreatment Research

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Improving the Quality of Care for Abused and Neglected Children

Child abuse research at CPCE focuses on improving quality of care delivered in the medical and child welfare systems to suspected victims of child maltreatment.

In 2011, 1 in 8 US children had a confirmed case of abuse or neglect, with the highest rates among young children. Hospitals have unique opportunities to detect child abuse through screening tools, such as a skeletal survey which reveals occult fractures. In fact, the American Academy of Pediatrics asserts that skeletal surveys be performed in all children under 2 years old suspected of being victims of physical abuse; yet, many hospitals fail to utilize these tools appropriately.

The aim for this line of CPCE research, led by Joanne Wood, MD, MSHP, is to improve occult injury screening practices for young children suspected of being victims of physical abuse.

An evaluation of the performance of occult injury screenings in hospitals across the US, using databases such as Premier Perspective and Pediatric Hospitals Information System (PHIS), found great variation in occult injury screening practices across US hospitals. At 366 hospitals evaluated (12 of which were pediatric), only 48 percent of children under 2 years old suspected of being victims of abuse were screened for occult injuries, with adjusted rates ranging from 15 percent to 100 percent.

At 40 pediatric hospitals in PHIS, the results were more promising: 83 percent of children under age 2 years suspected of being victims of abuse were screened for occult fractures, with adjusted rates ranging from 55 percent to 93 percent.

The researchers are now using the RAND/UCLA Appropriateness Method, which synthesizes the scientific literature and expert opinion for how best to implement science in the real world, to develop guidelines for clinicians on appropriate use of skeletal surveys.

Clinical guidelines for use of skeletal surveys in children under age 2 years presenting with fractures or bruises have been developed. These guidelines are being validated in a multi-center retrospective study. Also underway: guidelines for children under age 2 years presenting with traumatic brain injury.